HomeMy WebLinkAboutchange of sub contractor w PLANNING & DEVELOPMENT SER� ' - ,��
BUILDING & ZONING DIVISIONLAPR
02300 VIRGINIA AVE
FORT PIERCE, FL 34982 06 2(772)462-1553 FAX 462-1578 ounty,Flerr'!ling
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERM' T
PLEASE SELECT ONE OF THE FOLLOWING
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work There is a S50.00 fee for the Change of Contractor.
X CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is n® fee for
cancellation of the permit.
Date: —3L3��ZZ
Permit Number:
Site Address:
t
State License�NIC�Z� 777 SLC License Original GC,subcontractor r owner/buil er ---- --
i ��%kSll r^ �• 1' � /�yy
e--- C - - .... c�j I
State Licens i E�-l�l '��;Yf�SLC License � '�'I
New GC,subcontractor
Reason for Cancellation Contract Disputes
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change'of
LLetoifs bcontractor or cancellation of permit.A permit camn cancelled if work as been performed.
F�UeF OWNER(or ownerPouiider) '; A71lRE GENERAL Co
CTOR(or new GC,as applicable)
PRINT NAME W.Bryan Adams - ,
PRINT NAME _)ct. %l �LC tax ,
r
State of Florida,County of St.Lucie County
State of Florida,County of St.Lucie County #
The following instrument acknowledged before me this The following in ent was acknowledged before me this
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day°f /'fu ,Zo?? by�J,(1��L� .3�Itlay of rc,(_ ,20_?.2by -y.a o f
or o has p is personally mown t1_
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•.� 1 Nam• Sigiiature Date ��� ,•' SSION
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PERMIT#
=ISSUEE
® PLANNING 8�DEVELOPMENT' SERVICES�.�..�..._� Building& Cone Compliance
p ance Division
BUILDING PERMIT
SUBCONTRACTOR AGREEMENT
�(C
pany N e/tndividual Name) rhave agreed to bethe VAC
(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL Inc.
/J (Primary Contractor)
For the project located at
(Project Street Ad ess or
Property Tax ID#)
It is understood that,if there is any change of status regarding our participation with
Project, the Building and Code Regulation Division of St. Lucie Count will be the above mentioned
filing of a Change of Sub-contractor notice, Y advised pursuant to the
• I
�'CO T OR st GNATURE a(Qu lifter)
SUB-CONTRACTOR SIGRtTTURE(Qualifier) i
W. Bryan Adams
PRINT NAME - -
Jig.���•`l �--.�';:�,���},�,�-_ � -.
PRINT
29179
COUNTY CERTIFICATION NUMBER �..�� f
St Lucie COIINTYCERTIFICAT10NNUI4IBER
State of Florida,County of �
The foregoing instrument was signed before me Ihis� State of Florida,County of S e-
`C day of The foregoing instrument was Signed before me this
201,4y ��ll�r...— �—^ `day of i
/ fG� ZO O who la personally knows Y Or has produced a ? / `� �50
Who is personally known✓or has produced a
as to eaaon. �
as l e tifleation. I t
S[g ature of lyotary Public STAMP ,
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Print Name of No •• SS1pH �i� arQ �\ p,Et1k ST.kS,�
Public GH17
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N: P nt Name of Notary Public 3��\ 7Efo�� {
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PLANNING & REVELOPMENTSERX
BUILDING & ZONING DIVIS ION le CD
• 2300 VIRGINIA AVE
FORT' PIERCE, FL 34982 Apt 06 2022
(772) 462-1553 FAX 462-1578 5T. Lucie County .2rT
rfln i
':tjtin
CHANGE OF 1CONTRXC7'OR W
CANCELLATIONBCO,\`1'12A.CTOk OR OF 1'E4NIT
PLEASE',SEI-E
O—C'NE�()r THL—F-OLLOW-ING.
�CHANGE OF CONTRACTOR—Cliana
and the new e of Contractor is to be.signed an(I notarized by the property owner,
contractor Of I-ccord for file C1.1.1-rent permit. A new permit. application must also be cornpleteci
With nevv ice. of Commencement rnmr be filed in the new contractor's narne
for job values Urea(er than S2,500 (S7.500 if Af(--'. Change-out)- A recorded coPY inust be submitted prior to
colimiencing at); Work. There is a S50,00
'01Z _Subcon.tractor changes are to be conipleted bv
X CHANGE OFSUBCONTRACI fee fo r the Change of Co 11 t rac t o r.
The new Subcontractor must fill out a Subcontractor Aureellient Forin the general coll[ra,tor.
Contractor. There is a SSO.00 fee for th'e' Change of Sub-
-CANCULATION OF PERMIT
Cancellation of C811ceffafitan of a perrii"t is acceptable only il'llO wort, has'bccri done
PeR"It is to be signed and notarized by both tile owner and qualifier of'record. There is!
no
of the permit. no fee for
Date.: 3-C>/7
1 --------- Permit Number: 2-167 — 6�3LI
Site Address: Z-1 (5- 1 _.
0Y c-
-?(7-e TL
final C 3C,subconLrac.(Ol.or(lw1lel_,111.ti (jet. - Static License
71
Nett' 71U I
_SLC License
Reason fur C-J11CcllatiOJl
The undersigned does hereb 91-ec to hidenmjf-yand hotd —----------
c-0 8 fS, fees o r d it mq e 3 -isill hirnliess St Lucie Couilty, its Officots,a1zo.nts and cmpi1)ye031rrarTl alf
Colytt'ac(or'subco ftor""fly alld�111 cl1�111's Orac6on Cot-an%,reason,%vhicll
rltlaCto[*Or cancellationoi-perinit. A pet-l-riff cannot Err.cancer rise Is I-esull of this clllng�.(:)I,
if work has been performed.
'WrUR11 0F0v,,NFR (or
NAME StGN-Al URE GE4NS _, )R(or ric:\v cic.,,
npptitnbiel
flit FNIT
CNIIILY ui St.Lucic CoillIlv
hcrort�pie flit: SlArz.of Parid.l.('OufitY of St.bittic Crjj;jty
rb
t_1 Me,-1, dot?nt W19 it" (111111CRt%Vaack,-,(nvi-d,,cd bti',re this;
W. R
or%V], rude, ryll
I Who 11,2i P iduced as ID
Si
SignAturcurNotitry Dare
Public State dA r'c'a
erdZk�)41 "Yof Ubbiz State or Fiorlda
Ctary Public State of Apricia
ot Hannah E Moore
Hannah E Moore 0 Hannah E Moore
My Comm
OMMISSion HH 0 17099 My ,_m ss, HH017099
x p r.s 0 /0 ,20
Of Expires 07/01J`2024 MY COMMission HH
L-1 Expires 07101r2024
i
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
0
Building& Code Compliance Division
- - BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
i
i
Ehman Electrical Contractor, LLC
-- _ have agreed to be
(Company Name..Ind ivid ual Name) ---
the Electrical
Sub-contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor) j
For the project located at S�f�� Ly � fAkecr,�
.s rt,�— - —�----�- I(Project Street A r s or Prope Tax ID I/
I
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St, Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTORSIGNATCRE
{ ualifirrl SUBCONTRACTOR SIGNATURE(Qualifier)
W Bryan Adams Timothy L Ehman
__. PRINT NAME
29179
_ 31748 ;
COI NTl'CERTIFICATION NUMBER
CO CAT
NTY CERTIFIIO_N At'diBER
State of Florida,County of St Lucie ST LUCIE State or Florida,County of ��.�
The foregoing instrument nas signed before me this aday t The foregoing instrument was signed before me this/U"dsr of
�Gh 2CL_, W. Bryan Adams ---- --- -
- -- 1 - -- _ ----- - ,L�l ►tc ^ ,zoe, Timothy L Ehman
who is personally known ar has produced a who is personaly knou n or has produced a
as id lifccalion. as I'drollrtce Ion.
--.-.------__ STAhIP STAMP
Ss At ortY ar u�ticl SignalureorNotaryPdblic
P nl Name of N art Public \\\IIIIIMifY/ -� _
SPRA ST,4 Print Nemr of Notary Public
\ •QMµ1SSl0y yz
�GH2lO�•.
oo-00% Notary Public State of Florida
Laura Townsend
My commission
Revised I Ir16:2016 ;Z:.-AA q{•c 106177 *2 �'? c HH 175435
Z . oir� Exp.9/13/202S 1
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